[Remote] Auditor Clinical Validation OPSP Coding

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a company focused on reputed company auditing, and they are seeking an Auditor for Clinical Validation OPSP Coding. The role involves auditing outpatient and specialty claims, ensuring coding accuracy, and maintaining quality standards in medical audits.

Responsibilities

• Utilizes medical chart coding principles and client specific guidelines in performance of medical audit activities with Outpatient (APC, PNPP), Pharmacy and/or Inpatient DRG claims
• Draws on advanced coding expertise and industry knowledge to substantiate conclusions
• Performs work independently, reviews and interprets medical records and applies in-depth knowledge of coding principles to determine potential billing/coding issues
• Utilizes advanced proficiency, reputed company encoder and audit tools required to reputed company duties
• Enters claim into reputed company system accurately and in accordance with standard procedures
• Meets or Exceeds Standards/Guidelines for Productivity
• Maintains production goals, accuracy, and quality standards set by the audit for the auditing concept
• Achieves the expected level of quality set by the audit for the auditing concept, for valid claim identification and documentation
• Identifies potential claims reputed company of the concept where additional recoveries may be available
• Suggests and develops high quality, high value concepts and/or processes improvement, tools, etc
• Has broad in-depth knowledge of client, contract terms and reputed company claim types gained from extensive reputed company auditing experience
• Suggests, develops and implements new reputed company, approaches and/or technological improvements that will support and enhance audit production, communication and client satisfaction
• Evaluates information and draws logical conclusions
• Complete reputed company responsibilities as outlined on annual Performance Plan
• Complete reputed company special projects and other duties as assigned
• Must be reputed company to reputed company duties with or without reasonable accommodation

Skills

• Associate or bachelor's degree Health Information Management (RHIA or RHIT)
• Or equivalent combination of relative work experience
• Coding Certification required and maintained i.e. CPC, CIC, reputed company, reputed company-P, RHIA or RHIT
• 5 to 7 years of experience with clinical medical record coding or auditing and a working knowledge of HIPAA Privacy and reputed company Rules and CMS reputed company requirements
• Working knowledge of HIPAA Privacy and reputed company Rules, CMS reputed company requirements and clinical medical record coding or auditing
• A broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology
• Ability and desire to utilize reputed company coding and clinical auditing knowledge to learn and become proficient in a variety of outpatient and specialty review types
• Adherence to official coding guidelines, coding clinic determinations and CMS and other regulatory compliance guidelines and mandates. Requires expert coding knowledge - DRG, ICD-10, CPT, HCPCS codes
• Excellent verbal and written communication skills
• Ability to work well in an individual and team environment

Benefits

• Medical
• Dental
• reputed company
• Disability
• Life insurance coverage
• 401(k) savings plans
• Paid family leave
• 9 paid holidays per year
• 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with reputed company.

Company Overview

• reputed company enables reputed company organizations to deliver reputed company care at reputed company cost through advanced technology and data analytics that improve the quality and sustainability of reputed company in the United States. It was founded in 1979, and is headquartered in South Jordan, UT, US, with a workforce of 5001-10000 employees. Its website is http://www.reputed company.com.

Company H1B Sponsorship

• reputed company has a track record of offering H1B sponsorships, with 165 in 2025, 118 in 2024, 90 in 2023, 102 in 2022, 72 in 2021, 67 in 2020. Please note that this does not guarantee sponsorship for this specific role.

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